Microsoft PowerPoint - 55_Daily Question Preview Day 555 – Daily
Question Preview: Day 5 Moderator: Kieren Marr, MD
Daily Question Preview: Day 5
Moderator: Kieren Marr, MD
5.1
35yearold woman with AML day 15 after induction therapy.
Fever, chills, diffuse erythematous rash. Blood culture + GPC in
chains
Exam –
100/62, HR 120, grade 2 oral mucositis, and a diffuse,
blanching, erythematous rash. CXR
bilateral diffuse infiltrates.
She is receiving levofloxacin and acyclovir.
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.1
This is most consistent with infection with which of the following
organisms?
A) Streptococcus pneumoniae
C) Enterococcus faecalis
D) Streptococcus mitis
E) Stomatococcus mucilaginosus
5.1 This is most consistent with infection with which of the
following organisms?
A) Streptococcus pneumoniae
B) Coagulase-negative Staphylococcus
C) Enterococcus faecalis
D) Streptococcus mitis
E) Stomatococcus mucilaginosus
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.2
70yearold woman with AML, neutropenic for 15 days, s/p
induction chemotherapy develops fever, diarrhea, and abdominal
pain.
Exam
decreased bowel sounds and tenderness with deep
palpation in her RLQ.
CT shows inflammation in cecum. Levofloxacin and fluconazole
prophylaxis.
4 days prior to her admission for chemotherapy, she ate Chinese
food with fried rice.
5.2
Which is the most likely etiology?
A) Norovirus
D) Candida albicans
E) Bacillus cereus
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.2 Which is the most likely etiology?
A) Norovirus
D) Candida albicans
E) Bacillus cereus
5.3
35yearold F, 80 days after allogeneic BMT with 5 days of anorexia,
nausea, epigastric pain, and diarrhea.
CMV D/R+, HSV+, VZV+.
Exam: Faint maculopapular rash on upper body. Afebrile.
Meds: acyclovir, TMPSMX and fluconazole.
ANC 1000, ALC 250. LFTs normal.
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.3
What is the most appropriate initial workup and management?
A) Perform serum VZV PCR
B) Empiric corticosteroid treatment
D) CMV PCR, stool C. diff, bacterial culture
E) #D and upper, lower endoscopy
5.3 What is the most appropriate initial work-up and
management?
A) Perform serum VZV PCR
B) Empiric corticosteroid treatment
D) CMV PCR, stool C. diff, bacterial culture
E) #D and upper, lower endoscopy
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.4
40yearold male. Day 60 after allogeneic BMT from unrelated
donor, with bloody urine for 6 days.
Has skin GVHD, receiving a prednisone taper (1 mg/kg/day). Exam,
faint diffuse erythematous rash. Cr 1. LFTs normal. CMV pcr
negative.
5.4 The most likely etiology is:
A) Cyclophosphamide
B) CMV
C) EBV
D) BK
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.4 The most likely etiology is:
A) Cyclophosphamide
B) CMV
C) EBV
D) BK
E) JC virus
5.5 35yearold male 68 days
post allogeneic bone marrow
transplantation for myelodysplastic syndrome,
receiving methylprednisolone 500
mg for Grade III GVHD of the
gastrointestinal tract developed
fever, several painful, red skin
nodules and a blood culture
growing a mold.
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.5
The most likely fungus is which of the following:
A) Scedosporium apiospermum (Pseudallescheria
boydii)
B) Lomentospora (Scedosporium) prolificans
5.5 The most likely fungus is which of the following:
A) Scedosporium apiospermum (Pseudallescheria boydii)
B) Lomentospora (Scedosporium) prolificans
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.6
32yearold male with allogeneic hematopoietic stem cell transplant recipient for
AML, developed graft versus host disease, given high dose prednisone,
discharged and readmitted for fever not responding to antibacterial antibiotics.
These two chest
CT ’s, were taken at
admission and a week
later while he was
responding to voriconazole.
5.6
The most likely source of infection is:
A) Dirt from his garden
B) His oral flora
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.6 The most likely source of infection is:
A) Dirt from his garden
B) His oral flora
C) Contaminated food
D) Intravenous catheter
5.7
54yearold male 60 days postcardiac transplant was treated for
rejection with steroids when fever and a nontender anterior
cervical mass appeared.
Biopsy showed nodal replacement by lymphocytes, many of which
stained positively for EpsteinBarr virus as well as for the B cell
marker, CD20.
His plasma EBV viral load was 10,000 copies /ml.
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.7
The most appropriate treatment for this condition is:
A) Cidofovir
B) Ganciclovir
C) Acyclovir
D) Cyclophosphamide
E) Rituximab
A) Cidofovir
B) Ganciclovir
C) Acyclovir
D) Cyclophosphamide
E) Rituximab
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.8
52yearold female S/P cadaveric renal transplant receiving
tacrolimus, prednisone and mycophenylate.
Week 30 post transplant serum creatinine rose from 1.5 to 2.3
mg/dl.
Tacrolimus levels were in therapeutic range.
Urinalysis revealed one plus protein and no cells or casts.
5.8
Which would be most helpful in understanding if BK virus was causing her
renal failure?
A) Presence of decoy cells in urine cytology
B) Urine BK viral load
C) Urine culture for BK virus
D) Plasma BK viral load
E) Demonstration of BK inclusions in renal tubular epithelium on renal
biopsy
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.8 Which would be most helpful in understanding if BK virus was
causing her renal failure?
A) Presence of decoy cells in urine cytology
B) Urine BK viral load
C) Urine culture for BK virus
D) Plasma BK viral load
E) Demonstration of BK inclusions in renal tubular epithelium on
renal biopsy
5.9 Liver transplant recipient presented 21 days post transplant
with confusion, tremors, lethargy, anorexia
On bactrim & valganciclovir prophylaxis
Blood & urine cultures: negative
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.9 • Brain MRI: nonrevealing
•
Empiric intravenous ganciclovir, vancomycin, ceftriaxone & ampicillin
•
Day 6 Repeat MRI: diffuse encephalitis
•
Expired 13 days after neurologic symptom onset
•
Donor was previously healthy presenting with subarachnoid
hemorrhage
•
Toxicology screen: + cocaine & marijuana
• Recently on camping trip
A) CMV encephalitis
B) HHV6 encephalitis
C) VZV encephalitis
D) Rabies encephalitis
E) Cryptococcal meningitis
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.9 This presentation is most consistent with:
A) CMV encephalitis
B) HHV6 encephalitis
C) VZV encephalitis
D) Rabies encephalitis
E) Cryptococcal meningitis
6d fever, malaise, severe headache, dry cough, myalgia
• PMH: HTN
•Meds: Lisinopril/HCT
Visited pet shop 10d earlier
Parakeets, cockatiels
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.10 Exam: illtoxic, 40ºC P88
BP100/70 RR18 O2 97% RA
Lungs: clear
Neck: supple
Labs: WBC 5200, 26% B
Sputum: 1+ PMNs, no organisms
5.10
Which antibiotic will lead to the most rapid improvement?
A) Ceftriaxone
B) Gentamicin
C) Doxycycline
D) Trimethoprim/sulfamethoxazole
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.10 Which antibiotic will lead to the most rapid
improvement?
A) Ceftriaxone
B) Gentamicin
C) Doxycycline
D) Trimethoprim/sulfamethoxazole
Allergy: erythromycin (N/V)
• Oropharynx: Normal
• TMs: Normal
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.11 • Azithromycin prescribed
5.11
What is the most likely etiology?
A) Mycoplasma pneumoniae
B) Enterovirus D68
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.11 What is the most likely etiology?
A) Mycoplasma pneumoniae
B) Enterovirus D68
E) Drug reaction (azithromycin)
5.12
62yearold male living in an exurb of Phoenix, Arizona presents in
early September with a three day history of fever, myalgia, headache
and rash.
He works as a lineman for a utility company.
He lives with his family in an older adobe home with dogs.
He has beginnings of petechial features on the wrists and ankles.
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.12
Which of the following is the most likely diagnosis?
A) Human Monocytic Ehrlichiosis (HME)
B) Human Granulocytic Anaplasmosis (HGA)
C) Babesiosis
E) Tularemia
5.12 Which of the following is the most likely diagnosis?
A) Human Monocytic Ehrlichiosis (HME)
B) Human Granulocytic Anaplasmosis (HGA)
C) Babesiosis
E) Tularemia
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.13
48yearold male presents in October with fever
and rash
Supervisor for apartment building in Queens,
NY. Lives in cellar apt.
Exam: T 390C
brownblack 8mm eschar on RLE
~30 papulovesicular lesions on trunk
5.13
Which of the following Is the most likely etiologic agent?
A) R. rickettsii
B) R. parkeri
C) R. akari
D) R. conorii
E) Borrelia recurrentis
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.13 Which of the following Is the most likely etiologic
agent?
A) R. rickettsii
B) R. parkeri
C) R. akari
D) R. conorii
E) Borrelia recurrentis
5.14
43yearold visited southern Missouri on vacation, returns 7d later with
fever, headache and diffuse myalgia x 3d
Physical examination: no findings
• Hemoglobin: 7.0 g/dL, hematocrit: 24%
• Platelets: 105,000/mm³
• renal function: normal
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.14
Which of the following is the most likely etiologic agent?
A) Anaplasma phagocytophilum
B) Ehrlichia chaffeensis
C) Borrelia hermsii
D) Babesia divergens
E) Borrelia burgdorferi
5.14 Which of the following is the most likely etiologic
agent?
A) Anaplasma phagocytophilum
B) Ehrlichia chaffeensis
C) Borrelia hermsii
D) Babesia divergens
E) Borrelia burgdorferi
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.15
28yearold female presents with recurrent crampy
abdominal pain for several months.
She recently returned to the U.S. after living in Tanzania for two years.
Colonoscopy reveals small white papules.
Biopsy of a papule reveals an egg with surrounding granulomatous
inflammation.
5.15 Most likely diagnosis?
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.15 Most likely diagnosis?
5.16
A 6yearold boy from Indiana who has a pet dog and likes to
play in a sandbox presents with fever, hepatosplenomegaly,
wheezing, and eosinophilia.
He has never travelled outside the continental U.S.
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.16
The most likely causative agent acquired in the sandbox is:
A) Anisakis simplex
B) Onchocerca volvulus
C) Enterobius vermicularis
D) Toxocara canis
E) Anyclostoma braziliense
5.16 The most likely causative agent acquired in the sandbox
is:
A) Anisakis simplex
B) Onchocerca volvulus
C) Enterobius vermicularis
D) Toxocara canis
E) Anyclostoma braziliense
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.17
A 56yearold man from southern Missouri
Onset in July:
•Myalgia and malaise
Exam: T 37.0°C
Annular “bullseye” ~6 cm
(same area that engorged tick was removed earlier in the week)
5.17
Which of the following is the most likely diagnosis?
A) Lyme disease (Borrelia burgdorferi
infection)
B) Human Monocytic Ehrlichiosis (Ehrlichia
chaffeensis)
C) Borrelia mayonii
E) B. lonestarii infection
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.17 Which of the following is the most likely diagnosis?
A) Lyme disease (Borrelia burgdorferi infection)
B) Human Monocytic Ehrlichiosis (Ehrlichia chaffeensis)
C) Borrelia mayonii
E) B. lonestarii infection
5.18 A 41-year-old woman presented to a local emergency department
with a one day history of fever associated with swelling and
redness in her groin four days after returning from safari in
Tanzania.
Peripheral blood smear is obtained.
©2021 Infectious Disease Board Review, LLC
55 – Daily Question Preview: Day 5 Moderator: Kieren Marr, MD
5.18
What is the most likely diagnosis?
A) Leishmania donovani
B) Plasmodium vivax
C) Trypanosoma brucei
D) Wuchereria bancrofti
E) Leptospira interrogans
A) Leishmania donovani
B) Plasmodium vivax
C) Trypanosoma brucei
D) Wuchereria bancrofti
E) Leptospira interrogans